Psoriazis vulgaris hastalarında kontakt duyarlılık
Küçük Resim Yok
Tarih
2006
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Psoriazis, keskin sınırlı, eritemli plak veya papüller üzerinde yerleşmiş parlak, sedefi beyaz skuamlarla karakterize, genellikle simetrik yerleşimli, kronik inflamatuar bir deri hastalığıdır. Etyopatogenezi kesin bilinmeyen hastalığın genetik bir zeminde endojen ve ekzojen ajanların tetikleyici etkisiyle, özellikle de antijen sunan hücreler aracılığı ile T hücre aktivasyonu ve T hücrelerinin farklılaşmasındaki sapma ile ortaya çıktığı ileri sürülmektedir. Alerjik kontakt dermatit ise T hücre aracılı geç tip aşırı duyarlılık sonucu oluşan klinik bir tablodur. Önceden duyarlanılmış olan allerjen bir madde ile tekrar karşılaşıldığında gelişir ve yama testi, hastalığın tanısında yardımcı bir yöntem olarak kullanılmaktadır. Her iki hastalığın etyopatogenezinde de T lenfositleri ve Langerhans hücrelerinin rol alması, psoriaziste sağlam deriye uygulanan fiziksel ve kimyasal travmalarla lezyon oluşabilmesi, lezyonların süresi, hastalığın prognozu, kaşıntının şiddeti ve bazı psoriazis hastalarının tedaviye dirençli olması gibi nedenler altta yatan ve hastalığı başlatan ya da alevlendiren kontakt bir allerjen bulunabileceğini düşündürmektedir. Bu verilere dayanarak 35' i kadın, 15' i erkek 50 psoriazis hastasına ve 21 'i kadın, 14'ü erkek 35 kontrol olgusuna Avrupa standart serisi ile yama testi uygulanarak kontakt duyarlılık oranları karşılaştırıldı. Verilerin istatistik değerlendirmesi için Ki-kare, t test ve beklenen frekansın 5 'ten küçük olduğu dört gözlü tablolarda Fisher'in kesin Ki-kare testi kullanıldı. Psoriazisli hasalarda pozitiflik oranı %40 iken kontrol grubunda bu oran %31,4 idi (p=0,419). Hastalık süresi 5 yıldan uzun olanlarda ise 5 yıldan kısa olanlara göre daha yüksek oranda duyarlılık saptandı (p=0,038). Psoriazisli hastalarda en sık potasyum dikromata duyarlılık saptanırken kontrol grubunda en sık saptanan allerjen nikeldi. Psoriazisli hastalar ile kontrol grubu arasında kontakt duyarlılık açısından anlamlı bir fark saptanamamışken hastalık süresi 5 yıldan uzun sürenlerde yüksek oranda yama testi pozitifliğine rastlandı. Bu durum, bu hastaların yenilere göre çok daha çeşitli tedaviler almasına bağlandı. Literatürde, kullanılan topikal ilaçların da kontakt duyarlanma oluşturarak tedaviye direnç gelişmesine neden olabileceği bildirilmektedir. Bu nedenle seçilmiş hastalara 53psoriazis tedavisinde kullanılan ilaçlan da içeren genişletilmiş serilerle yama testi yapılması ve hastaların saptanan allerjenlerden sakınması tedaviye yardımcı olabilir.
Psoriasis is a chronic inflamatory skin disease which is usually symmetricaly located, characterized by sharply demarcated erithematous papules or plaques that are covered by shiny, silvery white scales. Though the etiopathogenesis of the disease is not clearly known, it is suggested that it is trigerred, on the genetical base, by the effects of endogen and exogen agents, especially antigen presenting cells via the T cell activation and deviation of T cell differentiation. Allergic contact dermatitis is caused by T cell mediated delayed type hypersensitivity. It develops when the patient is confronted with the same allergenic substance the patient became sensitized earlier and patch test is used as an assisting method in the diagnosis of the disease. Causes such as the role of T lymphocytes and Langerhans cells in both of diseases, the development of psoriatic lesions as a result of physical and chemical injuries occured on normal appearing skin, duration of the lesions, prognosis of the disease, intensity of itching and therapeutic resistance in some patients make the consideration of the possibilty of contact allergens underlying, causing and triggering the severity of the disease. Based on these data, the European Standart Patch Test Series was applied to 50 psoriatic patients (35 female, 15 male) and 35 control group patients (21 female, 14 male) and the ratios of contact sensitivity of both groups were compared. For statistical analysis of the data, Ki- square test, t test and Fisher's exact Ki-square test in which the expected frequency in four chamber tables is less than 5 was used. 40% of the psoriatic patients had positive patch test results while it is 31,4% for control group patients (p=0.419). It is also observed that the patients who had the disease for more than 5 years were more sensitive than those who had the disease for less than 5 years (p=0.038). Psoriatic patients frequently showed potassium dichromate sensitivity whereas control group patients had nickel allergy. Although the psoriatic patients and control group patients did not show significant difference in respect of the contact sensitivity, the patients who had the disease for more than 555 years had higher positive patch test. This condition was due to the fact that these patients were under a large variety of treatments than newer patients had. In the literature, it is noted that the topically used drugs may cause resistance to treatment by contact sensitivity occurence. Therefore, patch tests with extended series including drugs used in psoriasis treatment can be applied to selected patients and avoidence of the determined allergens might help to improve the treatment of psoriasis.
Psoriasis is a chronic inflamatory skin disease which is usually symmetricaly located, characterized by sharply demarcated erithematous papules or plaques that are covered by shiny, silvery white scales. Though the etiopathogenesis of the disease is not clearly known, it is suggested that it is trigerred, on the genetical base, by the effects of endogen and exogen agents, especially antigen presenting cells via the T cell activation and deviation of T cell differentiation. Allergic contact dermatitis is caused by T cell mediated delayed type hypersensitivity. It develops when the patient is confronted with the same allergenic substance the patient became sensitized earlier and patch test is used as an assisting method in the diagnosis of the disease. Causes such as the role of T lymphocytes and Langerhans cells in both of diseases, the development of psoriatic lesions as a result of physical and chemical injuries occured on normal appearing skin, duration of the lesions, prognosis of the disease, intensity of itching and therapeutic resistance in some patients make the consideration of the possibilty of contact allergens underlying, causing and triggering the severity of the disease. Based on these data, the European Standart Patch Test Series was applied to 50 psoriatic patients (35 female, 15 male) and 35 control group patients (21 female, 14 male) and the ratios of contact sensitivity of both groups were compared. For statistical analysis of the data, Ki- square test, t test and Fisher's exact Ki-square test in which the expected frequency in four chamber tables is less than 5 was used. 40% of the psoriatic patients had positive patch test results while it is 31,4% for control group patients (p=0.419). It is also observed that the patients who had the disease for more than 5 years were more sensitive than those who had the disease for less than 5 years (p=0.038). Psoriatic patients frequently showed potassium dichromate sensitivity whereas control group patients had nickel allergy. Although the psoriatic patients and control group patients did not show significant difference in respect of the contact sensitivity, the patients who had the disease for more than 555 years had higher positive patch test. This condition was due to the fact that these patients were under a large variety of treatments than newer patients had. In the literature, it is noted that the topically used drugs may cause resistance to treatment by contact sensitivity occurence. Therefore, patch tests with extended series including drugs used in psoriasis treatment can be applied to selected patients and avoidence of the determined allergens might help to improve the treatment of psoriasis.
Açıklama
Anahtar Kelimeler
Psoriasis, Kontakt duyarlılık, Contact sensitization, Yama testi, Patch test
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Kucur, M. K. (2006). Psoriazis vulgaris hastalarında kontakt duyarlılık. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Deri ve Zührevi Hastalıklar Anabilim Dalı, Konya.
